Effects of positive end-expiratory pressure on gas exchange and expiratory flow limitation in adult respiratory distress syndrome*

Koutsoukou, Antonia; Bekos, Basilis; Sotiropoulou, Christina; Koulouris, Nickolaos G.; Roussos, Charis; Milic–Emili, J.

doi:10.1097/00003246-200209000-00001

Cited by 85 publications

(82 citation statements)

References 34 publications

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“…It was found that almost all COPD patients who require mechanical ventilation are flow limited over the entire range of tidal expiration and that the supine posture promotes flow limitation [21][22][23][24][25][26]. Another study has shown that most patients with acute respiratory failure of pulmonary origin presented with EFLT while the ones with acute respiratory failure of extrapulmonary origin did not [24].…”

Section: Clinical Significance Of Expiratory Flow Limitationmentioning

confidence: 99%

“…This method does not require performance of FVC manoeuvres, collaboration on the part of the patient or use of a body-box. It can be used during spontaneous breathing in any body position [45], during exercise [18,46,47], and in ICU settings [21][22][23][24][25][26]. With this technique the volume and time history of the control and test expiration are axiomatically the same.…”

Section: Nep Techniquementioning

confidence: 99%

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Physiological techniques for detecting expiratory flow limitation during tidal breathing

Koulouris¹,

Hardavella²

2011

Eur Respir Rev

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Patients with severe chronic obstructive pulmonary disease (COPD) often exhale along the same flow-volume curve during quiet breathing as they do during the forced expiratory vital capacity manoeuvre, and this has been taken as an indicator of expiratory flow limitation at rest (EFLT). Therefore, EFLT, namely attainment of maximal expiratory flow during tidal expiration, occurs when an increase in transpulmonary pressure causes no increase in expiratory flow. EFLT leads to small airway injury and promotes dynamic pulmonary hyperinflation, with concurrent dyspnoea and exercise limitation. In fact, EFLT occurs commonly in COPD patients (mainly in Global Initiative for Chronic Obstructive Lung Disease III and IV stage), in whom the latter symptoms are common, but is not exclusive to COPD, since it can also be detected in other pulmonary and nonpulmonary diseases like asthma, acute respiratory distress syndrome, heart failure and obesity, etc. The existing up to date physiological techniques of assessing EFLT are reviewed in the present work. Among the currently available techniques, the negative expiratory pressure has been validated in a wide variety of settings and disorders. Consequently, it should be regarded as a simple, noninvasive, practical and accurate new technique.

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Section: Clinical Significance Of Expiratory Flow Limitationmentioning

confidence: 99%

Section: Nep Techniquementioning

confidence: 99%

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Koulouris¹,

Hardavella²

2011

Eur Respir Rev

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“…The presence of airway closure (Stage I) and EFL (Stage II) in the tidal volume range may promote peripheral airway injury and accelerate the abnormalities of lung function [7][8][9]. This enhances inflammation due to smoke per se, leading to severe functional and structural abnormalities within the lung.…”

Section: Conventional Techniquesmentioning

confidence: 99%

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

Calverley¹

2005

European Respiratory Journal

221

168

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Fashions in ideas, like clothes, come and go. From approximately 1950From approximately -1980, physiological research was seen as the key discipline in understanding lung disease and was at the cutting edge of pulmonary science. Subsequently, its importance has been down played amid a widely accepted but unfounded assumption that we now have a perfect working understanding of the physiological behaviour of the respiratory system in health and disease. Although it seems improbable that completely new disciplines within respiratory physiology will emerge with fundamentally different ways of describing the mechanical or gas exchanging function of the lung, advances in computing and new observations in disease have highlighted previously unsuspected physiological abnormalities that have changed the way we view lung disease and the interface between disordered lung mechanics, symptomatology and disability. This is especially true for the two related physiological concepts of expiratory flow limitation and dynamic hyperinflation, which are now being taken from the physiological laboratory to the bedside with dramatic effect. Each arises from well-established theoretical and practical observations first made 40 yrs ago and now adapted to a range of settings, particularly in the field of obstructive lung disease. This review focuses on how these conditions are defined and assessed and what evidence there is that they might be important in lung disease.

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“…Increased R max , rs in ARDS patients has been previously described [20,23] and attributed to decreased lung volume and time-constant inequalities [22,24]. In elderly subjects R max , rs have been described to be normal [25] or slightly decreased [26].…”

Section: Discussionmentioning

confidence: 99%

ARDS in Aged Patients: Respiratory System Mechanics and Outcome

Koutsoukou¹,

Katsiari²,

Orfanos³

et al. 2017

Health Sci J

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Background: Aging is associated with physiological changes in respiratory mechanical properties. In elderly patients an increased incidence of Acute Respiratory Distress Syndrome (ARDS) resulting in increased number of elderly patients treated in Intensive Care Units (ICUs), along with increased mortality has been reported. Aim of the present study was to identify potential age-related differences in respiratory mechanics, gas exchange and ventilator settings in patients with early ARDS. The relationship between age and ICU mortality was additionally assessed.

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Effects of positive end-expiratory pressure on gas exchange and expiratory flow limitation in adult respiratory distress syndrome*

Cited by 85 publications

References 34 publications

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Physiological techniques for detecting expiratory flow limitation during tidal breathing

Flow limitation and dynamic hyperinflation: key concepts in modern respiratory physiology

ARDS in Aged Patients: Respiratory System Mechanics and Outcome

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